1. Professional Development Training: Utilization of the Behavioral Risk Factor Surveillance System (BRFSS) Data LaTonya Bynum Arkansas BRFSS Survey Coordinator October 25, 2011

2. Outline o Overview of BRFSS survey o History and purpose of BRFSS o Survey Methods o Process for Adding Questions o Review of BRFSS survey results o Demonstration on how to access data o Examples of BRFSS Data to Action

3. Behavioral Risk Factor Surveillance System BRFSS is a random digit dial telephone survey that collects health information from adults on behaviors that put health at risk for premature death and disease. Six benefits of the survey: 1)Covers most health topics 2)Identifies health disparities 3)Public data use file 4)Results can be viewed online 5)Data collected annually 6)FREE Technical assistance

4. In the 1980s research showed health behaviors play an important role in unnecessary deaths and diseases. In 1984 CDC started the state-based BRFSS to collect health information on risk behaviors and health practices that affect health status. By 1997 all states were participating. BRFSS History

5. BRFSS Survey Design

6. Telephone Surveys Households with a telephone are selected

7. People 18 and older are randomly selected Random Sample

8. Interviewers are Trained

9. Computer Assisted Telephone Interview Telephone Interview Data Entry

10. Calls are made 7 days a week 2,300 – 2,500 calls per month More than 100,000 calls nationwide per year

11. Data Collection Arkansas BRFSS contracts with Clearwater Research Interviews are monitored to maintain and ensure data quality. Data are sent to state & CDC CDC aggregates monthly data for the entire year. Final data are available by March of the following survey year.

12. Data are weighted...  to compensate for unequal selection probability  to ensure that data can be used to represent the Arkansas adult population

13. Arkansas BRFSS Facts & Update Data collected continuously since 1993 Sample sizes range: 1,764 – 5,732 Sends out monthly advance letters Moving towards multimodal survey & new weighting procedure Cell phone data collection began in 2009 Oversampling for Blacks and Hispanics

15. 1) Core Asked by all states 2) Optional Modules Specialized topic questions states can choose to include 3) State-added questions State specific questions to address state and local issues Design of BRFSS Questionnaire

16. ~ $1,200 - $1,300 per question July 1 planning for next annual survey begins New question proposals are due by September Proposals are reviewed in October Pre-testing of state added questions begins October December questionnaire is finalized New questions are included on survey from January 1 – December 31 How to add BRFSS Questions

17. CDC Required Response Rate: 40.0% Arkansas BRFSS 2010 Response Rate: 53.0% Response Rate for 2010

18. Who uses it?  State and Local Health Departments  Students and Researchers  Non-Profit Agencies  Federal Agencies  Research organizations  Insurance companies  Media

19. How it is used?  Plan and implement programs like the UAMS Disability and Health Program  Develop plans to reduce the burden of Diabetes, Obesity, Heart Disease, and Tobacco  Identify health disparities across the state  Prepare grant proposals for state and local level projects  Conduct public health awareness campaigns for the Arkansas BreastCare program  Publish scientific articles in professional journals

20. BRFSS TOBACCO CANCER CONTROL ALCOHOL DISABILITY DIABETES OBESITY/ OVERWEIGHT ORAL HEALTH HEALTH CARE ACCESS WOMEN’S HEALTH MENTAL HEALTH + 100 OTHER TOPICS 3 IMMUNIZATION INJURY ELDER HEALTH DEPRESSION RACISM BRFSS Topics of Interest... HIV or STD SLEEP

21. Physical Activities or Exercise

23. Percentage of Persons 18 and Older Participating in Any Physical Activities or Exercises In The Past Month By State, 2010 BRFSS Source: http://apps.nccd.cdc.gov/gisbrfss/default.aspx

28. Nutrition: Consumption of 5 Fruits and Vegetables Per Day

30. Source: http://www.brfss.ar.gov

35. HIV Testing Results

37. Source: http://www.brfss.ar.gov

43. Strengths State and County Estimates State based survey Timeliness Cost SMART-BRFSS (Statistical Metro-/Micropolitan Risk Trends) – Cities & counties with 500+ observations GIS and mapping capability – State and county-level Linking to other data sources – EPA & Census data Launching follow-up surveys of subpopulations identified in BRFSS – Asthma Follow-up

44. Weaknesses Self Reported Small cell sizes Telephone coverage Technology barriers Non-response Recall bias Language barriers Non-institutionalized population

45. How to Access BRFSS Data Submit requests to latonya.bynum@arkansas.gov Tables, charts, fact sheets, GIS maps, or data files AR BRFSS County Estimates: www.brfss.ar.gov Click on BRFSS Maps Click on County Data Click on report of choice (2004 – 2010:xls) CDC BRFSS: www.cdc.gov/brfss Click on BRFSS Maps Click on Prevalence Data and Trends Data Click on SMART: City and County Data

46. CDC Prevalence and Trends WebQuery is a web based tool provided by BRFSS Data can be exported to Excel List data for all states Compare state to state or state to nation Review or print graph of BRFSS data Copy graph and insert into presentation or report View trend data by year, state to state, and by respondent answer choice

47. http://apps.nccd.cdc.gov/brfss/index.asp Bookmark it! This is the main page: You can pull-down the menus to search for information by state, year and category.

48. Select the state of interest, “Arkansas.” Select the year, “2010.” Select the category, “Overweight and Obesity (BMI).” and Press the “Go” Option.

49. Select the option for “Weight classification by Body Mass Index (BMI)” by clicking here.

50. Click the drop down menu and select the option for “Grouped by Race” and click “Go” button.

51. This shows the percent of Black adults who reported they are obese “44.5”. This shows the Race Category is “Black”, % (Percent), CI (Confidence Intervals), and n (number of people who were interviewed).

52. Resources at www.brfss.ar.govwww.brfss.ar.gov Arkansas BRFSS Presentations - Presentations that include Arkansas BRFSS data Arkansas BRFSS Publications - Strategic plans, factsheets, and documents that include Arkansas BRFSS data Arkansas BRFSS Quick Links - National query systems that include Arkansas BRFSS data Arkansas BRFSS Optional Module Data - CDC tabulated reports that include Arkansas BRFSS data on specific health topics Arkansas BRFSS GIS Maps - Geographic Information System (GIS) maps that visually display Arkansas BRFSS county data estimates

53. Program Modification The University of Arkansas Medical Sciences (UAMS) Partners for Inclusive (PIC) Communities Office Modifies the Arkansas Disability and Health Program The UAMS Partners for Inclusive Communities (PIC) used the BRFSS information to target their health promotion efforts. After finding disparities in rates of obesity among persons who have a disability, the PIC implemented a new health intervention (Living Well with a Disability) at local independent living centers in 2007.

54. Change In Policy Clean Indoor Air Act Protects the Public from Secondhand Smoke: Act 8 According to the BRFSS, current smoking prevalence among Adults in Arkansas was 23.5% in 2005, compared with 20.5% nationwide. In April 2006, state lawmakers used the BRFSS data to support their decision to pass the Arkansas Clean Indoor Act, which prohibits smoking in work and public places, including bars and restaurants.

55. Appropriation of Funds State Legislator Appropriates $2 Million for Implementation of the Arkansas Cancer Plan BRFSS data on breast and cervical cancer were included in the Arkansas Cancer Facts and Figures publication which was used to educate the Arkansas Legislative Public Health Welfare and Labor Committee as well as foster support for improving public health in Arkansas. Through broad-based collaborative action, $2 million was successfully secured for implementation of the Arkansas Cancer Plan.

56. A powerful tool for health professionals. BRFSS

57. LaTonya Bynum Arkansas BRFSS Survey Coordinator LaTonya.Bynum@arkansas.gov www.brfss.ar.gov Toll Free Phone: 1-800-462-0599 EXT. 2003 Questions…